1. Rutgers, The State University of New Jersey Community Support Services Training Supervisor Series – Session 8 Zakia Clay, MSW, LCSW Zakia.Clay@shrp.rutgers.edu Ann Reilly, MA, LSW, CPRP Reillya2@shrp.rutgers.edu Anthony Zazzarino, MA, LPC, CPRP Anthony.Zazzarino@shrp.rutgers.edu

2. Department of Psychiatric Rehabilitation & Counseling Professions Learning Objectives Utilize teach back method to reinforce learning Describe the characteristics of a crisis Increase understanding of the impact of trauma on the ability to work toward recovery Summarize the Community Support Service (CSS) model Identify ways to begin transitioning to Community Support Services (CSS)

3. Department of Psychiatric Rehabilitation & Counseling Professions Review Session 7 1.Establish a rationale for learning the skill 2.Discuss the steps of the skill 3.Model the skill 4.Ask a person to try out the skill 5.Provide positive feedback 6.Provide corrective feedback 7.If needed, ask the person to try using the skill again 8.Provide additional feedback (positive & corrective) 9.If training in a group have other members do steps 4-8 10.Encourage practice of the skill in natural environments (homework) (Bellack, 2004)

4. Department of Psychiatric Rehabilitation & Counseling Professions Additional Techniques & Considerations Pacing to determining optimal number of sessions for a specific skillPrompting Supplementary modeling Discrimination modeling Role playingCoaching (Bellack, 2004)

5. Department of Psychiatric Rehabilitation & Counseling Professions What is Teach-back? A way to make sure you—the support worker—explain information clearly. It is not a test or quiz of [consumers]. Asking a consumer to explain in their own words what they need to know or do, in a caring way. A way to check for understanding and, if needed, re-explain and check again. A research-based health literacy intervention that improves [consumer]-provider communication and patient health outcomes. (Schillinger, 2003)

6. Department of Psychiatric Rehabilitation & Counseling Professions 10 Elements for Using Teach-back Effectively 1.Use a caring tone of voice and attitude. 2.Display comfortable body language and make eye contact. 3.Use plain language. 4.Ask the [consumer] to explain back, using their own words. 5. Use non-shaming, open-ended questions. (Schillinger, 2003)

7. Department of Psychiatric Rehabilitation & Counseling Professions 10 Elements for Using Teach-back Effectively 6.Avoid asking questions that can be answered with a simple yes or no. 7.Emphasize that the responsibility to explain clearly is on you, the provider. 8.If the [consumer] is not able to teach back correctly, explain again and re-check. 9.Use reader-friendly print materials to support learning. 10.Document use of and [consumer] response to teach-back ( Schillinger, 2003)

8. Department of Psychiatric Rehabilitation & Counseling Professions Teach Back Activity Break up into groups of 3 –One will be the teacher –One will be the learner –One will be the observer Facilitator will provide each group with an informational handout Teacher will read the information and teach the learner the information Learner will use teach back to ensure understanding Observer will provide feedback to the smaller group and then to the larger group

9. Department of Psychiatric Rehabilitation & Counseling Professions Crisis Intervention A face-to face, short term intervention with a consumer who is experiencing increased distress and/or an active state of crisis Includes developing and implementing recipient’s crisis contingency plan and Psychiatric Advanced Directive (Larosiliere, 2011)

10. Department of Psychiatric Rehabilitation & Counseling Professions Approach to crisis intervention Goal: Restore pre-crisis level of functioning Interventions: –Rapidly establish the relationship –Examine the dimensions of the problem –Explore and assess past coping attempts –Explore alternatives and specific solutions –Restore functioning through implementation of an action plan –Follow up

11. Department of Psychiatric Rehabilitation & Counseling Professions Characteristics of Support Worker Self awareness Non judgmental Non reactive High tolerance Specific training

12. Department of Psychiatric Rehabilitation & Counseling Professions Possible Outcomes Relapse Aggressiveness / Destructiveness Homicide Impulsive or Self-Injurious Behavior Suicide Other Crises Resolution – our goal is to restore at least previous level of functioning

13. Department of Psychiatric Rehabilitation & Counseling Professions Suicide 10 th leading cause of death in US (NJ 49 th ) 38,364 suicides in US in 2010 Males complete 3.7 times more but women attempt 3 times more Men use firearms (56%) and women use poison /overdose (34%). Caucasians and the elderly complete most Divorced, widowed and single more than married (Kinter, 2013)

14. Department of Psychiatric Rehabilitation & Counseling Professions Available Services Every county has at least one crisis unit and one screening center: –Crisis units do emergency psychiatric evaluations and can refer people to outpatient services or voluntary hospitalization. –Screening centers do these services but also do mobile outreach and involuntary hospitalization.

15. Department of Psychiatric Rehabilitation & Counseling Professions Community Outreach Referral to Services Admission Emergency Evaluation Process

16. Department of Psychiatric Rehabilitation & Counseling Professions Psychiatric Advanced Directive A psychiatric advance directive (PAD) is a legal plan that allows a person to specify important information for caregivers in the event of a mental health crisis. The PAD can provide valuable information for providers to reference and follow during that difficult time. (MHANJ, 2015)

17. Department of Psychiatric Rehabilitation & Counseling Professions Psychiatric Advanced Directive An individual may choose to register a psychiatric advance directive with the state. This is optional. If it is registered, the plan will be kept at a confidential central registry and is available to be accessed at any time (24/7) by an authorized health professional. –The benefit of registering a psychiatric advance directive is that the treating medical professional or screening center can get a copy of the plan in a timely manner. (MHANJ, 2015)

18. Department of Psychiatric Rehabilitation & Counseling Professions Psychiatric Advanced Directive MHANJ Psychiatic Advanced Directive

19. Department of Psychiatric Rehabilitation & Counseling Professions Relapse Prevention Plan Activity

20. Department of Psychiatric Rehabilitation & Counseling Professions Trauma-Informed Approach Realizes the widespread impact of trauma and understands potential paths for recovery Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system Responds by fully integrating knowledge about trauma into policies, procedures, and practices Seeks to actively resist re-traumatization (SAMHSA, 2015)

21. Department of Psychiatric Rehabilitation & Counseling Professions Trauma-Informed Approach A trauma-informed approach can be implemented in any type of service setting or organization Distinct from trauma-specific interventions or treatments that are designed specifically to address the consequences of trauma and to facilitate healing (SAMHSA, 2015)

22. Department of Psychiatric Rehabilitation & Counseling Professions Principles of a Trauma- Informed Approach Safety Peer support Empowerment Trust Collaboration Multicultural Awareness (SAMHSA, 2015)

23. Department of Psychiatric Rehabilitation & Counseling Professions Informing Services It is critical to promote the linkage to recovery and resilience for those individuals and families impacted by trauma Services and supports that are trauma-informed: –build on the best evidence available –consumer and family engagement, empowerment, and collaboration (SAMHSA, 2015)

24. Department of Psychiatric Rehabilitation & Counseling Professions Trauma-Specific Interventions The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers (SAMHSA, 2015)

25. Department of Psychiatric Rehabilitation & Counseling Professions Jeopardy Review

26. Department of Psychiatric Rehabilitation & Counseling Professions Current service delivery and Community Support Services (CSS) Comprehensive Rehabilitation Needs Assessment Individualized Rehabilitation Plan Skill Development IMR Trainings Crisis Intervention Coordination of Services

27. Department of Psychiatric Rehabilitation & Counseling Professions 3 Goals of the Wellness and Recovery Approach Quality of Life Recovery Community Integration

28. Department of Psychiatric Rehabilitation & Counseling Professions Final Thoughts

29. Department of Psychiatric Rehabilitation & Counseling Professions References Bellack, A.S., Mueser, K.T., Gingerich, S. & Agresta, J. (2004). Social Skills Training for Schizophrenia, 2 nd Edition. New York: Guildford Press. Kinter, K. (2013). Crisis intervention and prevention [Power Point Presentation]. Larosiliere, V (2011). Community Support Services [memo]. Retrieved from http://www.state.nj.us/humanservices/dmhs/info/CS S_Notice_to_providers.pdf. Mental Health Association of New Jersey (MHANJ). (2013, July 15). Psychiatric advanced directive. Retrieved on November 10, 2015 from http://www.mhanj.org/psychiatric-advance-directives/.

30. Department of Psychiatric Rehabilitation & Counseling Professions References Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2014). Psychiatric rehabilitation. (3rd ed.). San Diego, CA: Elsevier Inc. Schillinger, D. (2003). Always use teach-back [pdf format]. Retrieved from http://www.teachbacktraining.org/assets/files/PDFS/Teach%20 Back%20-%2010%20Elements%20of%20Competence.pdf. Substance Abuse and Mental Health Services Administration (SAMHSA). (2015, August 14). Trauma-informed approach and trauma-specific interventions. Retrieved November 4, 2015, from http://www.samhsa.gov/nctic/trauma-interventions.